The reasons underlying why autoimmune diseases overwhelmingly affect women more than men are not clear. Nor are the reasons why autoimmune disease is more prevalent in families. This review uses primary biliary cirrhosis (PBC) as a model autoimmune disease to discuss the familial risk, focusing mainly on mother-daughter pairs. PBC is a chronic cholestatic liver disease characterised by an immune-mediated inflammatory destruction of the small intrahepatic bile ducts, with fibrosis progressing to cirrhosis and subsequent liver failure. Epidemiological studies have demonstrated that first degree relatives of PBC patients are at higher risk of developing PBC, as well as other autoimmune diseases. This is especially true for the mothers, daughters and sisters of PBC patients. Multiple case reports have highlighted the complexity of mother-daughter pairs in PBC, and the need for follow-up of these individuals when one member of the pair is diagnosed with PBC. It may be the case that diagnosis in one individual may lead to early diagnosis in the other, even if they are asymptomatic. Early management of PBC may improve the prognosis in these patients. This review will examine the literature surrounding PBC in mothers and daughters.
"The disease predominantly affects middle-aged women and is practically absent in children or youngsters    . PBC affects more than one member within the same family, and several reports indicate that first degree relatives of PBC patients have an increased risk of developing the disease  . The prevalence of the disease varies among countries, with a recent systematic review indicating prevalence to be 1.91–40.2 "
[Show abstract][Hide abstract] ABSTRACT: Primary biliary cirrhosis (PBC) is a progressive cholestatic liver disease characterised serologically by cholestasis and the presence of high-titre antimitochondrial antibodies, and histologically by chronic nonsuppurative cholangitis and granulomata. As PBC is a granulomatous disease and
is the most frequent cause of granulomata, a causal relation between tuberculosis and PBC has been suggested. Attempts to find serological evidence of PBC-specific autoantibodies such as AMA have been made and, conversely, granulomatous livers from patients with PBC have been investigated for molecular evidence of
. This paper discusses in detail the reported data in support or against an association between
infection and PBC. We discuss the immunological and microbiological data exploring the association of PBC with exposure to
. We also discuss the findings of large epidemiologic studies investigating the association of PBC with preexistent or concomitant disorders and the relevance of these findings with tuberculosis. Genome-wide association studies in patients with tuberculosis as well as in patients with PBC provide conclusive hints regarding the assumed association between exposure to this mycobacterium and the induction of PBC. Analysis of these data suggest that
is an unlikely infectious trigger of PBC.
[Show abstract][Hide abstract] ABSTRACT: Primary biliary cirrhosis (PBC) is a chronic, cholestatic, autoimmune liver disease characterised by the destruction of small- and medium-sized bile ducts. The serological hallmark of PBC includes antimitochondrial antibodies (AMA). The disease has a striking female predominance, and primarily affects women of middle-age. First-degree relatives, and in particular female relatives, are known to have an increased risk of developing the disease. Several studies have attempted to explain the female predominance of PBC, and autoimmune diseases in general. Two components that are of interest in PBC include monosomy X and xenobiotics. Monosomy X has been noted to be prevalent in the peripheral blood mononuclear cells of PBC patients. Xenobiotics, which are exogenous chemicals not normally found within the body, have been implicated in the modification of, and loss of, tolerance to AMA. Several cosmetics are known to contain these xenobiotics, which is of interest given the information provided in regards to known risk factors for PBC development. This review will focus on X monosomy and xenobiotics, which appear to constitute the X-factor of PBC.
[Show abstract][Hide abstract] ABSTRACT: Primary biliary cirrhosis (PBC) is a progressive cholestatic liver disease characterized by the autoimmune destruction of the biliary epithelial cells of the small and medium-size bile ducts. The disease affects middle aged women and usually affects more than one member within a family. The pathognomonic serological hallmark of the disease is the presence of circulating anti-mitochondrial antibodies, and disease-specific anti-nuclear antibodies. Susceptibility genes and environmental risk factors such as infections and smoking have been reported as important for the development of the disease. Among the environmental agents, infectious triggers are the best studied. Most of the work published so far has investigated the role of infections caused by Novosphingobium aromaticivorans and Escherichia coli. This review will discuss the popular and unpopular infectious agents causatively linked to PBC. It will also examine reports investigating the epidemiological aspects of the disease and their direct or indirect implications to bacterial-induced PBC.
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